How Do You Know Which Therapy Is Best For You?

When it comes to tackling mental health problems, or even just easing yourself through life's rough patches, we've all heard the saying "A problem shared is a problem halved." Of course, it's not always quite that simple, but talking therapies can be a really effective way of working things through.

There's a pretty wide range of options out there, with varying levels of availability and waiting times, depending on your area and ability to pay. But, particularly when you’re feeling vulnerable, the overwhelming abundance of mental health terms can be confusing to try and navigate. Do you need counselling or psychotherapy? A psychologist or a psychiatrist? It's a lot to unpick – so here's a breakdown of some of the different therapies available to help you out.

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Counselling

Ok, this is where the confusion starts – 'counselling' is often used as an umbrella term to cover all talking therapies, but it's also a specific type of talking therapy, usually provided by either a counsellor or a counselling psychologist.

"In general, counsellors are equipped to deal with life problems, such as divorce, bereavement or redundancy," chartered psychologist Louise Watson explains. "Counselling is typically for what we call the 'worried well' – people who don't have a mental illness, but who have a problem they need to sort through, need a sounding board, to grieve, to sort out their emotions about something, or just go and offload really," she adds.

Counselling is quite widely available on the NHS, referred through your GP, or you can find a private counsellor in your area using a directory like Counselling Directory or RSCPP. Many charities and community organisations also offer counselling services, either for general support or aimed at tackling specific problems. These might include: Cruse Bereavement Care, Relate, Rape Crisis, or your local Mind.
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Cognitive Behavioural Therapy (CBT)

When it comes to more specific mental health problems, CBT is the therapy you're most likely to have heard of – because it's the most readily available therapy on the NHS for conditions like depression, bipolar, anxiety, eating disorders, addiction, insomnia, and now even psychosis.

"CBT focuses on cognitions, which are thought patterns and beliefs, and linked behavioural patterns," Louise says. Therapists work with their clients to understand how their thoughts, feelings and behaviours are interconnected. They then work together on strategies to challenge unhelpful thought and behaviour patterns, and experiment with new behaviours, which are practised through homework tasks.

There's been a lot of research into CBT, and it's been adapted to treat almost all common mental health conditions, with pretty high success rates. "It's particularly effective for things like anxiety, where people are in a lot of distress and want a quick fix to reduce their symptoms in the here and now," Louise explains.

"It's very widely available on the NHS – in the first instant, for mild depression or anxiety, in a computerised form. Then, if that's not helpful, you can be referred for one-to-one or group CBT on the NHS," she adds.

If there's a long waiting list and/or you'd prefer to go private, you'll also find plenty of practitioners offering CBT face-to-face, online, via Skype or over the phone, some more affordably than others. If you do go for the online approach, it's worth remembering it works best for those suffering from milder cases. The National Institute for Health and Care Excellence recommends a programme called 'Beating The Blues' for mild depression and anxiety and FearFighter for mild panic, phobia and anxiety disorders.
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Psychodynamic Therapy

At the opposite end of the talking therapies spectrum, there's psychodynamic therapy. Unlike CBT, psychodynamic therapy is much less about immediate solutions in the here and now, and instead focuses on how childhood experiences have affected your relationships and emotions in the present.

In its most recognisable form you've got the intensive Freudian-style psychoanalysis, where you're lying on a couch talking while your therapist listens. The kind of psychodynamic therapy you'll most commonly find is more structured but still draws influence from Freudian ideas, among others. "It might appeal to somebody who has deeper-rooted issues and wants to have the therapy focused on an exploration of those background problems, and how they present themselves today," Louise says.

"There's a big focus on the therapeutic relationship, and the kind of outcome you might expect would be more about increased awareness and understanding of the root causes of your problems, improved self-esteem, and a greater sense of self-acceptance."

Psychodynamic therapy (or psychotherapy) may be available on the NHS, depending on your area, or can be accessed privately through an organisation like the British Psychoanalytic Council.
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Mindfulness-Based Therapies

Mindfulness
is the trendy treatment du jour, loved by celebrities from Ruby Wax to Gwyneth Paltrow. But what actually is it? "Mindfulness really doesn't mean anything fancy, it's just about gaining some distance from your thoughts and being able to observe your mind," explains clinical psychotherapist Imi Lo.

"It's not necessarily about meditating, although it can be. With mindfulness-based therapies you would learn techniques to observe your mind, and to be more aware of your own thoughts and feelings, on top of the normal talking therapies," she says. Most commonly, mindfulness is combined with CBT to make mindfulness-based cognitive therapy (MBCT). There's a lot of evidence that this is effective – particularly, Imi says, to prevent relapses into depression or addiction, as well as for anxiety, stress reduction, and general pain management.

A number of NHS Trusts offer MBCT, and there's no shortage of private MBCT therapists and mindfulness courses on the market. The Mental Health Foundation also runs the Be Mindful project, which includes an online mindfulness course and a directory of approved teachers.
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Group Therapy

Group therapy can sound daunting, but the form known as 'experiential group therapy' is particularly suitable for conditions like social anxiety, body dysmorphia, or anything to do with how you relate to people and how you see yourself in relation to others.

"Experiential groups are usually a freeform discussion between group members, talking about their experiences and feelings, and giving each other constructive feedback," Louise explains. "The point of those groups is about helping people become more comfortable with their own experience, allowing themselves to bring up the emotions associated with whatever they're talking about, and sharing it with other people."

The other type of group therapy, known as psychoeducational therapy, has a more seminar-like format and involves teaching a group of people skills, such as stress management, over a series of classes. This type of group therapy is particularly common on the NHS, Louise says, "and more so as budgets are tight, because it's a cost-effective way of teaching those skills".

Experiential groups are less common, but are available. They're typically not suitable for people with more severe or deep-rooted mental health problems.
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Dialectical Behaviour Therapy (DBT)

DBT is a branch of CBT, designed specifically as a treatment for people with borderline personality disorder (BPD), but can also be used to treat anyone who struggles with interpersonal relationships, impulse control, or emotional regulation.

"Skill training is a big part of DBT, and there are four main areas: mindfulness; distress tolerance, where you learn skills to use when you're in a crisis; interpersonal relationships, where you learn to be assertive and to communicate better; and emotional regulation, where you learn about the nature of emotions and how to regulate them," Imi explains.

"It's not as widely available in the UK as in the US, but where you do get it on the NHS you would usually have both group and individual therapy, and it would be managed by a team, so you would feel very taken care of," she adds. "It doesn't necessarily have to be that way though, an individual therapist can work with you one-on-one on DBT skills."
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Eye Movement Desensitisation and Reprocessing (EMDR)

EMDR is one of the treatments recommended for post-traumatic stress disorder (PTSD) and other forms of trauma. It was initially developed to treat one-off traumas, like a sexual assault or a car accident, but is increasingly used for more complex or long-term traumas, such as childhood abuse.

"It works on a neurological level, restructuring your memories – so it reaches a place where talking doesn't, and that's why it's so powerful," Imi says. "You'd go into the session and the practitioner would gather some history. Then, it may sound a bit weird, but the traditional way of doing it is your eyes follow certain movements of the practitioner's finger while you process some of the traumatic memories."

She adds: "It's a very widely recommended therapy for trauma, with some good research behind it, but it's still relatively new. On the NHS it's usually only available in trauma clinics, or you can find trained practitioners online, but it's not very common yet."
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Accessing help

This is by no means an exhaustive list, but it should give you a clearer picture of some of the options available and what might work best for your needs. None of these therapies is guaranteed to work for everyone, and you might have to go through a bit of trial and error to find one that suits you.

In most cases, your first port of call should be your GP to discuss the options available on the NHS. Going in armed with some information on the specific things you're after can make that conversation easier, especially if they try to fob you off.

It's also worth noting that, regardless of the therapy you choose, your relationship with the therapist is almost always the most important factor in how successful your therapy will be. When you go for an initial session, think about your chemistry with the therapist as much as the type of treatment they're offering.
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